INFORMATION REQUIRED FOR WORK PERMIT APPLICATION

1. NAME –
2. OTHER NAMES USED –
3. SEX – MALE
4. MARITAL STATUS –
5. DATE OF BIRTH -
6. CITY OF BIRTH –
7. COUNTRY / REGION OF BIRTH –
8. NATIONALITY -
9. DO YOU HOLD OR HAVE YOU HELD ANY OTHER NATIONALITY -
10. ARE YOU A PERMANENT RESIDENCE OF ANOTHR COUNTRY/REGION OTHER THAN WHAT IS LISTED ABOVE
11. NATIONAL ID NUMBER -
12. HOME ADDRESS –
13. CITY –
14. COUNTRY -
15. POSTAL ZONE / ZIP CODE –
16. SAME MAILING ADDRESS -
17. PRIMARY PHONE NUMBER –
18. SECONDARY PHONE NUMBER –
19. WORK PHONE NUMBER –
20. email address –
21. PASSPORT TYPE –
22. PASSPORT NUMBER –
23. COUNTRY / AUTHORITY THAT ISSUED PASSPORT OR TRAVEL DOCUMENT -
24. CITY WHERE ISSUED –
25. COUNTRY WHERE ISSUED -
26. ISSUE DATE –
27. EXPIRY DATE –
28. HAVE YOUR PASSPORT EVER BEEN LOST OR STOLEN -
29. HAVE YOU EVEN BEEN TO THE USA -
30. IF ‘YES’ LIST DATE AND LENGTH OF STAY FOR LAST 5 TIMES –
31. TYPE OF VISA –
32. VISA ISSUE DATE -
33. VIST EXPIRY DATE –
34. HAVE YOU EVER BEEN REFUSED A U.S. VISA OR BEEN REFUSED ENTRY INTO THE UNITED STATES OR
WITHDRAWN YOUR APPLICATION FOR ENTRY AT THE PORT OF ENTRY -

35. HAS ANYONE EVER FILED AN IMMIGRATION PETITION ON YOUR BEHALF WITH THE UNITED STATES
IMMIGRATION SERVICES -

36. HAVE YOU BEEN TEN-PRINTED -

EDUCATION:
37. NAME OF SECONDARY / TERTIARY SCHOOL ATTENDED –
38. ADDRESS OF SECONDARY / TERTIARY SCHOOL ATTENDED –
39. COURSE OF STUDY – ACADEMICS OR VOCATIONAL –
40. DATE ATTENDANCE FROM -
41. DATE OF ATTENDANCE TO -
42. DO YOU BELONG TO A CLAN OR TRIBE -
43. PROVIDE LIST OF LANGUAGES YOU SPEAK -
44. HAVE YOU TRAVELLED TO ANY COUNTRIES / REGIONS WITHIN THE LAST 5 YEARS
45. IF ‘YES’ LIST COUNTRIES / REGIONS VISITED –
46. HAVE YOU BELONGED TO, CONTRIBUTED TO OR WORKED FOR ANY PROFESSIONAL, SOCIAL OR
CHRITABLE ORGANZATIONS -
47. DO YU HAVE ANY SPECIALIZED SKILLS OR TRAINING SUCH AS FIREARMS, EXPLOSIVES, NECULEAR,
BIOLOGICAL OR CHEMICAL EXPERIENCE -
48. HAVE YOU EVER SERVED IN THE MILITARY
49. HAVE YOU EVEN SERVED IN IR BEEN A MEMBER OF, OF BEEN INVOLVED WITH A PARAMILITARY UNIT,
VIGILANTE UNIT, REBEL GROUP, GUERRILLA GROUP OR INSURGENT ORGANIZATION -

WORK:
50. PRIMARY OCCUPATION -
51. SPECIFY –
52. CURRENT EMPLOYER/SCHOOL NAME –
53. CURRENT EMPLOYER/SCHOOL ADDRESS
54. START DATE
55. WORK PHONE NUMBER
56. MONTHLY SALARY IN LOCAL CURRENCY
57. DESCRIBE DUTIES BRIEFLY
58. WERE YOU PREVIOUSLY EMPLOYED
59. EMPLOYER NAME
60. EMPLOYER ADDRESS
61. TELEPHONE NUMBER
62. JOB TITLE
63. SUPERVISOR’S SURNAME
64. SUPERVISOR’S FIRST NAME
65. EMPLOYMENT DATE FROM
66. EMPLOYMENT DATE TO
67. DESCRIBE DUTIES BRIEFLY

FAMILY:
68. FATHER’S SURNAME -
69. FATHER’S FIRST NAME -
70. FATHER’S DATE OF BIRTH
71. IS FATHER IN THE U.S -
72. MOTHER’S SURNAME -
73. MOTHER’S FIRST NAME -
74. MOTHER’S DATE OF BIRTH –
75. IS MOTHER IN THE U.S -
76. DO YOU HAVE ANY IMMEDIATE RELATIVES, NOT INCLUDING PARENTS IN THE U.S -
77. DO YOU HAVE ANY OTHER RELATIVES IN THE U.S -
78. SPOUSE’S FULL NAME INCLUDING MADIEN NAME –
79. SPOUSE’S DATE OF BIRTH –
80. SPOUSE’S NATIONALITY -
81. SPOUSE’S CITY OF BIRTH –
82. SPOUSE’S COUNTRY OF BIRTH -

83. WOULD YOU COLLECT THE PASSPORT OR DO YOU WANT IT DELIVERED

84. IF DELIVERY…STATE PERSON’S NAME

85. MOBILE TELEPHONE NUMBER

86. ADDRESS